HERBAL MONOGRAPHS LICORICE/471Antiviral/Antifiingal EffectsGlycyrrhizin suppresses the secretion of hepatitis B virus
(HBV) surface antigen (HbsAg) in patients with HBV. The
compound is thought to bind to hepatocytes at a concentra-
tion able to modify the expression of HBV-related antigens
on the hepatocytes and suppress sialylation of HbsAg (Sato,
1996). Glycyrrhizin stimulates interferon gamma produced
by T-cells for an antiviral effect against influenza virus
infection (Utsunomiya, 1997). Antiviral action of glycyrrhiz-
in on the human immunodeficiency virus (HIV) occurs by
inhibiting replication through interference with virus-cell
binding and also suppression of giant cell formation. (Ito,
1987; Nakashima, 1987). Glycyrrhizin induces CD4 T cells,
which suppress type 2 cytokines produced by burn-associ-
ated type 2 T cells. This improves resistance to Candida
alibicans associated with thermal injury (Utsunomiya, 1999).Mineralcorticoid EffectsLicorice inhibits the enzyme 11-beta- hydroxysteroid dehy-
drogenase in the kidney, which leads to decreased transfor-
mation of Cortisol into cortisone. The mineralocorticoid
action of Cortisol causes a decrease in serum potassium and
an increase in serum sodium concentration resulting in
retention of water, causing weight increase and hypertension
(Palermo, 1996). Glycyrrhetic acid, the hydrolytic metabolite
of glycerrhizic acid causes the inhibition of peripheral
metabolism of Cortisol and produces a pseudo-aldosterone-
like effect (Heikens, 1995). Licorice induces high blood
pressure also through inhibition of NADPH-dependent short
chain dehydrogenase/reductase enzymes in the kidney
(Duax, 1998).
MisceUerteoys. EffectsGlabridin has been shown to inhibit UVB induced pigmenta-
tion and erythema in skins of giunea pigs (Yokota, 1998).
Isoliquiritin inhibits granuloma angiogenesis in a concentra-
tion dependent manner (Kobayashi, 1995). Glycyrrhizin has
therapeutic effects on liver dysfunction associated with
cytomegalovirus infection (Numazaki, 1994). Glycyrrhizin
has complementary effects on intracelluar calcium mobiliza-
tion to block neuromuscular transmission (Dezaki, 1995).
Licorice exerts a choleretic effects through glycyrrhizin and
other unknown components (Raggi, 1995).
CLINICAL TRIALS
Gastric UlcerA double-blind study involving thirty-four patients was
conducted to compare carbenoloxalone and pirenzepine for
treatment of a chronic gastric ulcer. Carbenoxalone was
administered as 300 mg daily for 1 week followed by 150
mg daily for 5 weeks. Pimzepine was administered as 150
mg daily for 6 weeks. There was no significant difference
between the groups at the end of the treatment period with
ulcers healed in 59% of the pirenzepine group and in 52% of
the carbenoxolone group. The healing rates in this study do
not compare well with reported treatment success rates of
H2-receptor antagonists (Bianchi, 1985).
Peptic UlcerA randomized, single-blind trial compared the efficacy of
deglycyrrhizinated licorice (Caved-S®) to cimetidine in 100
patients with peptic ulcer disease. The patients were adminis-
tered either cimetidine 200 mg 3 times daily plus 400 mg at
night or Caved-S plus antacid combination, 2 tablets to be
chewed 3 times a day between meals. Caved-S® was as
effective as cimetidine for healing peptic ulcers over 6 and
12 weeks but was slower in reducing night pain from peptic
ulcer. The medications were equally effective and superior to
placebo for the prevention of recurrences with peptic ulcers.
Endoscopic evaluation showed healing of ulcers in 60% and
66% of the Caved-S and cimetidine groups, respectively at
the end of 6 weeks. After 12 weeks, healing had occurred in
88% and 94%, respectively (Morgan et al, 1982).
HepatitisA retrospective study evaluated the long-term use of a
glycyrrhizin-containing solution for prevention of hepatocel-
lular carcinoma (HCC) in patients with chronic hepatitis C.
One-hundred and ninety-two patients with chronic hepatitis
C were included in the study. Stronger Neo-Minophagen C
(SNMC), an intravenous solution containing 0.2% glycyr-
rhizin, 0.1% cysteine, and 2% glycine in physiologic
solution, 100 milliliters (mL) daily was administered to 83
patients over an 8 week period, then followed by 2 to 7 times
per week for 2 to 16-years (median 10.1 years). The other
109 patients were treated with other herbal remedies, such as
vitamin K, for 1 to 16 years (median, 9.2 years). The 10-year
rate occurrence of HCC were 7% in the SNMC treatment
group and 12% respectively in the non-SNMC treatment
group. The 15-year rate was 12% in the SNMC treatment
group and 25% in the other treatment group (p=0.032).
Elevated alanine aminotransferase (ALT), a characteristic of
chronic hepatitis and a risk factor for the development of
HCC normalized in 35.7% in the SNMC treatment group,
which was significantly better than the 6.4% of the other
treatment group (Arase et al, 1997).INDICATIONS AND USAGE
LICORICE ROOT
Approved by Commission E:- Cough/bronchitis
- Gastritis
Unproven Uses: The drug is used for catarrh of the upper
respiratory tract as well as for gastric/duodenal ulcers. In